Retropubic Versus Transobturator Midurethral Slings for Stress Incontinence

This chapter summarizes the results of the Trial of Mid Urethral Slings (TOMUS), in which women with stress urinary incontinence were randomized to a retropubic midurethral sling versus a transobturator sling. Bladder perforations and voiding dysfunction occurred only in the retropubic sling group; neurologic symptoms (weakness and numbness) were significantly more common in the transobturator group. Both objective and subjective measures of treatment success at 12 months were similar. Based on this and subsequent studies, retropubic and transobturator midurethral sling approaches appear to have similar outcomes at 12 months for the treatment of stress urinary incontinence. However, the approaches differ in their adverse-event profiles.

Delayed Presentation of Iliac Vein Injury: A Severe Complication at Retropubic Midurethral Sling Arm Removal

Midurethral slings are the most common treatment for female stress urinary incontinence. Perioperative vascular injuries during placement of a retropubic midurethral sling (RMUS) are uncommon but have been described. The objective of this case report is to describe a complication of delayed presentation from a vascular injury at the time of retropubic sling arm removal not previously documented in the literature. This life-threating complication should be considered and precautions should be taken at retropubic sling arm removal. Prevention is accomplished by proper visualization of pelvic vasculature and/or eliminating tension on sling before excision.